替格瑞洛联合比伐卢定在ST段抬高型心肌梗死患者直接PCI治疗中的应用

Effect of ticagrelor combined with bivalirudin in patients with ST-segment elevation myocardial infarction during primary percutaneous coronary intervention

目的探讨替格瑞洛联合比伐卢定对于ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行直接经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)治疗的临床疗效。方法回顾性分析来梅州市人民医院行PPCI治疗的98例STEMI患者的临床资料,根据就诊顺序按随机数字表法分为两组:观察组46例,术中给予替格瑞洛联合比伐卢定治疗;对照组52例,手术前给予患者口服阿司匹林及替格瑞洛,术中给予肝素。结果治疗后,观察组心肌梗死溶栓试验(thrombolysis in myocardial infarc-tion,TIMI)血流分级高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组顽固性心绞痛、出血、呼吸困难等情况的发生均低于对照组,其中观察组出现5例(10.17%)上述情况,而对照组则出现11例(21.16%),差异有统计学意义(P<0.05)。两组PPCI治疗成功率均为100%。观察组PPCI治疗后心源性死亡、支架血栓、再发心肌梗死发生率均显著低于对照组,差异有统计学意义(P<0.05);其中观察组未出现上述情况,而对照组则出现5例上述情况,但两组术后均未发生卒中。观察组治疗总有效率达到84.78%,而对照组为78.84%。结论替格瑞洛联合比伐卢定在TIMI血流分级、术后治疗结果等疗效方面优于单用替格瑞洛治疗组,且术后不良事件发生率较低。

Objectives To discuss the clinical effect of ticagrelor combined with bivalirudin in patients with ST-segmentelevation myocardial infarction（STEMI）during primary percutaneous coronary intervention（PPCI）.Methods Totally 98 patients with STEMI in emergency department of Meizhou People′s Hospital were given retrospective analysis.According to the order of treatment,they were randomly divided into two groups：46 patients in observation groupwere given ticagrelor combined with bivalirudin treatment during PPCI;52 patients in control group were given oralaspirin and ticagrelor before PPCI,and given heparin during PPCI.Results Thrombolysis in myocardial infarction（TIMI）blood flow classification of patients in observation group after treatment was significantly higher than that ofpatients in control group（P〈0.05）.Occurrence of refractory angina,bleeding,dyspnea and other conditions of patientsin observation group were lower than those of patients in control group（P〈0.05）.There were 5（10.17%）cases of theabove sumptoms and events in observation group and 11（21.16%）cases in control group（P〈0.05）.Success rate ofPPCI in both the two groups were 100%.Incidences of cardiac death,stent thrombosis,and myocardial infarctionof observation group after PPCI were significantly lower than those of control group（P〈0.05）.There were no aboveconditions in observation group,while there were 5 cases with above conditions in control group.No stroke occurred inboth the two groups after PPCI.Total effectiveness rate of observation group was 84.78%,while total effectiveness rateof control group was 78.84%.Conclusions TIMI blood flow classification and treatment efficacy of ticagrelor combined with bivalirudin are better than those of single ticagrelor treatment,and with lower incidence of postoperativeadverse events.